The sticks and carrots of health care reform

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Kai Ryssdal: Here's another educated guess as we move on. We're all probably more familiar with the Commerce clause of the Constitution now than we were earlier this week. A federal judge ruled on Monday the government can't use the powers in that clause to force people to buy health insurance. The Supreme Court will probably have to decide. But a lot of people have started looking at that part of the health care law known as the individual mandate more closely.

We asked Gregory Warner at the Health Desk at WHYY in Philadelphia whether there might be an alternative to it.

Gregory Warner: First I called Randall Bovbjerg. He's a senior fellow at the Urban Institute. He told me this:

Randall Bovbjerg: The mandate is a very important but not totally essential part of this approach to get everybody to buy coverage. It's the stick, there is a carrot.

The carrot is the part of the reform law that makes insurance more affordable, the subsidies and regulations. To stay with that analogy, just a moment, some of those now praising the federal judge for striking down that individual mandate say, "We need more carrots!"

Jamie Court is author of "The Progressive's Guide to Raising Hell."

Jamie Court: So the key to getting people in to the health care system doesn't have to do with the stick of a tax penalty, it has to do with the carrot.

Make insurance affordable enough and people will buy in.

Stuart Altman: If the carrot is beautifully wrapped, and very expensive, of course!

Stuart Altman, professor of health economics at Brandeis University, says the country can't afford that carrot. He says -- barring some more draconian way of lowering health costs -- the only alternative to the individual mandate is another stick, like making insurance more expensive each year you don't buy it.

Ron Pollack is with Families USA.

Ron Pollack: You could call it an incentive or you could call it a stick. But it would make people think twice not to purchase insurance.

Pollack says that would a punier stick than the individual mandate. There's a big stick, of course, that no one talks about -- except for Randall Bovbjerg, who got me started on this whole carrot-and-sticks analogy.

Bovbjerg: And that is, that if you truly want to opt out of insurance, you have to opt out for good! No fair opting out now and then if you're hit by a truck opting in.